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| __NOTOC__
| | #REDIRECT[[HIV AIDS overview]] |
| {{AIDS}}
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| {{CMG}}
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| ==Overview==
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| '''Acquired immune deficiency syndrome''' ('''AIDS''') is a [[syndrome|collection of symptoms and infections]] resulting from the specific damage to the [[immune system]] caused by the [[HIV|human immunodeficiency virus]] (HIV) in humans,<ref>{{cite web
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| |url=http://www.niaid.nih.gov/Publications/hivaids/hivaids.htm
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| |title=The Relationship Between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome |publisher= NIAID
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| |accessdate=2008-03-10}}</ref> and similar viruses in other species ([[Simian immunodeficiency virus|SIV]], [[Feline immunodeficiency virus|FIV]], etc.). The late stage of the condition leaves individuals susceptible to [[opportunistic infection]]s and [[tumor]]s. Although treatments for AIDS and HIV exist to decelerate the [[virus]]'s progression, there is currently no known cure. HIV is [[Transmission (medicine)|transmitted]] through direct contact of a [[mucous membrane]] or the bloodstream with a [[bodily fluid]] containing HIV, such as [[blood]], [[semen]], [[vaginal fluid]], [[preseminal fluid]], and [[breast milk]].<!-- And NOT through body fluids like saliva and tears, see references--><ref name=CDCtransmission>{{
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| cite web
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| | author=[[Divisions of HIV/AIDS Prevention]]
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| | publisher=[[Centers for Disease Control & Prevention]] | year= 2003
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| | url=http://www.cdc.gov/HIV/pubs/facts/transmission.htm
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| | title=HIV and Its Transmission
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| | accessdate = 2006-05-23
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| }}</ref><ref name=sfaf>{{
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| cite web
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| | author=[[San Francisco AIDS Foundation]]
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| | publisher=
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| | year= [[2006-04-14]]
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| | url=http://www.sfaf.org/aids101/transmission.html
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| | title=How HIV is spread | accessdate = 2006-05-23
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| }}</ref> This transmission can come in the form of [[anal sex|anal]], [[vaginal sex|vaginal]] or [[oral sex|oral]] [[Sexual intercourse|sex]], [[blood transfusion]], contaminated [[hypodermic needle]]s, exchange between mother and baby during [[pregnancy]], [[childbirth]], or [[breastfeeding]], or other exposure to one of the above bodily fluids.
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| ==Classification==
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| Since June 5, 1981, many definitions have been developed for [[epidemiology|epidemiological]] surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the [[World Health Organization]] staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the [[Centers for Disease Control and Prevention|Centers for Disease Control]] (CDC) Classification System is used.
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| ==Pathophysiology==
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| Human Immunodeficiency virus causes AIDS by depleting [[CD4+]] [[T helper]] [[lymphocyte]]s. T lymphocytes are essential to the immune response and without them, the body cannot fight infections or kill [[cancer]]ous cells. Thus the weakened [[immune system]] allows [[opportunistic infection]]s and [[neoplastic]] processes. The mechanism of CD4+ T cell depletion differs in the [[acute]] and [[chronic]] phases, to sum it all AIDS has a complex pathophysiology.<ref name="pmid8040596">{{cite journal |author=Guss DA |title=The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1 |journal=J Emerg Med |volume=12 |issue=3 |pages=375–84 |year=1994 |pmid=8040596 |doi= |url= |accessdate=2012-04-27}}</ref>
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| ==Differentiating AIDS from other Diseases==
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| AIDS is an immunodeficiency disease. It should be considered in patient presenting with symptoms of [[immunodeficiency]]. AIDS should be distinguished from [[congenital]] disorders and considered in the differential diagnosis of childhood immunodeficiency.
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| The possibility of HIV infection should be considered on a case-by-case basis and other causes of immune suppression must be considered.
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| Various medical conditions that cause immunosuppression are [[chemotherapy]], [[immune]] disorders, [[severe combined immune deficiency]] [SCID], severe [[malnutrition]].
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| ==Epidemiology and Demographics==
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| Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century.<ref name=Gao>
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| {{ cite journal
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| | author=Gao F, Bailes E, Robertson DL, et al
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| | title=Origin of HIV-1 in the Chimpanzee Pan troglodytes troglodytes
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| | journal=Nature
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| | year=1999
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| | pages=436–441
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| | volume=397
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| | issue=6718
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| | pmid=9989410 |doi=10.1038/17130
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| }}</ref> It is now a [[pandemic]]. In 2007, an estimated 33.2 million people lived with the disease worldwide, and it claimed the lives of an estimated 2.1 million people, including 330,000 children. Over three-fourths of these deaths occurred in sub-Saharan Africa, retarding economic growth and destroying human capital [[antiretroviral drug|Antiretroviral]] treatment reduces both the [[Mortality rate|mortality]] and the morbidity of HIV infection, but routine access to antiretroviral [[medication]] is not available in all countries.<ref name=Palella>{{
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| cite journal
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| | author=Palella FJ Jr, Delaney KM, Moorman AC, et al
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| | title=Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators
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| | journal=N. Engl. J. Med | year=1998 | pages=853–860 | volume=338 | issue=13
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| | pmid=9516219
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| }}</ref>
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| HIV/AIDS [[social stigma|stigma]] is more severe than that associated with some other life-threatening conditions and extends beyond the disease itself to providers and even volunteers involved with the care of people living with HIV.<ref name=Snyder>{{
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| cite journal |
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| | author=Snyder M, Omoto AM, Crain AL |
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| | title=Punished for their good deeds: stigmatization for AIDS volunteers |
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| | journal=American Behavioral Scientist | year=1999 | pages=1175–1192 | volume=42 | issue=7 | doi=10.1177/0002764299042007009
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| }}</ref>
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| In 2010, an estimated 34 million people were living with HIV, of whom more than 30 million were living in low- and middle-income countries.
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| ==Screening==
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| At the end of 2006, an estimated 1,106,400 persons (range: 1,056,400 – 1,156,400) in the United States were living with HIV. CDC estimates that 56,300 new HIV infections occurred in the United States in 2006.<ref name="pmid18677024">{{cite journal |author=Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, Karon J, Brookmeyer R, Kaplan EH, McKenna MT, Janssen RS |title=Estimation of HIV incidence in the United States |journal=JAMA |volume=300 |issue=5 |pages=520–9 |year=2008 |month=August |pmid=18677024 |pmc=2919237 |doi=10.1001/jama.300.5.520 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18677024 |accessdate=2012-02-23}}</ref> About 1 million Americans have HIV — to a surprise, an estimated 25 percent do not know they have the [[infection]]. Therefore, HIV screening is important to both extend their lives and prevent further spreading of the disease.
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| ==Diagnosis==
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| ===Laboratory Findings===
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| A number of laboratory tests are important for initial evaluation of HIV-infected paients. Two surrogate markers ([[AIDS laboratory tests#CD4 T-Cell Count|CD4 T-cell count (CD4 count)]], [[AIDS laboratory tests#Plasma HIV RNA Testing|plasma HIV RNA]]) are routinely used to asses immune function and level of viral [[viremia]].
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| ===Electrocardiogram===
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| The [[pericardium]] is frequently involved in HIV infections. Also medications used in AIDS therapy can cause EKG changes.
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| ===Chest X Ray===
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| Chest X-ray is an extremely common procedure done to evaluate the organs located in the chest area i.e. [[lungs]], [[heart]], and [[chest wall]]. It also helps in diagnosing the cause of various symptoms. (for example persistent [[cough]], [[shortness of breath]], [[chest pain]] or [[injury]], and [[fever]])
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| ===CT===
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| CT scans of chest are important part of diagnosis in HIV patients having [[pulmonary]] symptoms. It has an advantage over X-Ray in being more sensitive in detection of early [[interstitial lung disease]], [[lymphadenopathy]], and [[nodules]].
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| ===MRI===
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| Magnetic resonance imaging or MRI is used in great deal for the care of HIV-positive patients. MRI is the first-choice among neuroimaging modality in the workup for [[AIDS dementia complex]]. An MRI is more sensitive than a head CT in determining if a lesion is truly solitary.
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| ===Echocardiography===
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| Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing heart disease and they may need an [[echocardiogram]].
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| ==Treatment==
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| ===Medical Therapy===
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| The primary goal of antiretroviral therapy (ART) is to reduce HIV-associated [[morbidity]] and [[mortality]]. This goal is best accomplished by using effective ART to maximally inhibit HIV replication, as defined by achieving and maintaining [[plasma]] HIV [[RNA]] ([[viral load]]) below levels detectable by commercially available [[assay]]s. Durable viral suppression improves immune function and quality of life, lowers the risk of both AIDS-defining and non-AIDS-defining complications, and prolongs life. Based on emerging evidence, additional benefits of ART include a reduction in HIV-associated [[inflammation]] and possibly its associated complications.
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| ===Surgery===
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| HIV infected patients may require surgery to treat infections and diseases associated with the condition. Childbirth and [[organ transplant]] are two of the many conditions that may require surgery in a HIV patient.
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| ===Primary Prevention===
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| There is currently no [[HIV vaccine|vaccine]] or cure for [[HIV]] or AIDS. The only known methods of prevention are based on avoiding exposure to the virus or, failing that, an antiretroviral treatment directly after a highly significant exposure, called [[post-exposure prophylaxis]] (PEP).
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| ===Cost-Effectiveness of Therapy===
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| HIV and AIDS retard economic growth by destroying human capital. Without proper [[nutrition]], health care and medicine that is available in developed countries, large numbers of people are falling victim to AIDS. They will not only be unable to work, but will also require significant medical care. The forecast is that this will likely cause a collapse of economies and societies in the region. In some heavily infected areas, the epidemic has left behind many orphans cared for by elderly grandparents.<ref name=Greener>{{cite book
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| | author =Greener R
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| | year = 2002
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| | title = State of The Art: AIDS and Economics
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| | chapter = AIDS and macroeconomic impact
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| | editor = S, Forsyth (ed.)
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| | pages = 49–55
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| | publisher = IAEN
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| }}</ref>
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| ===Future or Investigational Therapies===
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| Research to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage [[drug resistance]]. A number of studies have shown that measures to prevent [[opportunistic infection]]s can be beneficial when treating patients with HIV infection or AIDS. [[Vaccination]] against [[hepatitis]] A and B is advised for patients who are not infected with these viruses and are at risk of becoming infected.<ref name=Laurence>{{
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| cite journal
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| | author=Laurence J
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| | title=Hepatitis A and B virus immunization in HIV-infected persons
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| | journal=AIDS Reader | year=2006 | pages=15–17 | volume=16 | issue=1
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| | pmid=16433468
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| }}</ref> Patients with substantial [[immunosuppression]] are also advised to receive prophylactic therapy for [[Pneumocystis jiroveci pneumonia]] (PCP), and many patients may benefit from prophylactic therapy for [[toxoplasmosis]] and [[Cryptococcus]] [[meningitis]] as well.<ref name=PEPpocketguide>{{
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| cite web
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| | publisher=Department of Health and Human Services
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| | date = 2007-02-02
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| | url=http://www.guideline.gov/summary/summary.aspx?ss=14&doc_id=6223&string=infected+AND+patients
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| | title=Treating opportunistic infections among HIV-infected adults and adolescents. Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America.
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| | accessdate = 2007-02-05
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| }}</ref>
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| Daily multivitamin and mineral supplements have been found to reduce HIV disease progression among men and women. This could become an important low-cost intervention provided during early HIV disease to prolong the time before antiretroviral therapy is required.<ref name=Fawzi>{{
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| cite journal
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| | author=Fawzi W, Msamanga G, Spiegelman D, Hunter DJ
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| | title=Studies of vitamins and minerals and HIV transmission and disease progression
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| | journal=J. Nutrition| year=2005 | pages=938–944 | volume=135 | issue=4
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| | pmid=15795466
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| }}
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| </ref> Some individual nutrients have also been tried.<ref name=Hurwitz>([[Selenium]]:) {{
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| cite journal
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| | author=Hurwitz BE, Klaus JR, Llabre MM, Gonzalez A, Lawrence PJ, Maher KJ, Greeson JM, Baum MK, Shor-Posner G, Skyler JS, Schneiderman N
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| | title=Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation: a randomized controlled trial
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| | journal=Arch Intern Med.| year=2007 | pages=148–155 | volume=167 | issue=2
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| | pmid=17242315
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| }}</ref><ref name=Cathcart1>([[Vitamin C]]:) {{
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| cite journal
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| | author=Cathcart RR
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| | title=Vitamin C in the Treatment of Acquired Immune Deficiency Syndrome
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| | journal=Medical Hypotheses | year=1984 | volume=14 | issue=4 | pages=423-433
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| | pmid=6238227 | doi=10.1016/0306-9877(84)90149-X
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| | url=http://www.doctoryourself.com/aids_cathcart.html
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| }}</ref> Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS.<ref name=Ferrantelli>{{
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| cite journal
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| | author=Ferrantelli F, Cafaro A, Ensoli B | title=Nonstructural HIV proteins as targets for prophylactic or therapeutic vaccines |journal=Curr Opin Biotechnol. | year=2004 | pages=543–556 | volume=15 | issue=6
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| | pmid=15560981
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| }}</ref> It has been postulated that only a vaccine can halt the pandemic because a vaccine would possibly cost less, thus being affordable for developing countries, and would not require daily treatments.<ref name=Ferrantelli/> However, after over 20 years of research, HIV-1 remains a difficult target for a vaccine.<ref name=Ferrantelli/>
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| ==References==
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| {{reflist|2}}
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| [[Category:HIV/AIDS]]
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| [[Category:Disease]]
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| [[Category:Immune system disorders]]
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| [[Category:Infectious disease]]
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| [[category:viral diseases]]
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| [[Category:Pandemics]]
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| [[Category:Sexually transmitted infections]]
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| [[Category:Syndromes]]
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| [[Category:Virology]]
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| [[Category:AIDS origin hypotheses]]
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| [[Category:Medical disasters]]
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| [[Category:Acronyms]]
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| [[Category:Immunodeficiency]]
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| [[Category:Microbiology]]
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| [[Category:Grammar]]
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| [[Category:Needs overview]]
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| {{WH}}
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| {{WS}}
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